New ministers will have had their Week One briefings, learning what the NHS and officials wants them to know and think. 

The culture of NHS England, an organisation soon to be abolished, is that whatever is done is always the best it could be, and that whether the outcome is any good should never be questioned. Cover-ups are better than bad headlines, a culture which drives many decisions about data centralisation. Data decisions are made in a Gray meeting room where past precedent protects voyeurs, creeps, and ghouls, prevents improvement and ignores patient wishes. Whether the FDP has a repository is something that mostly in public is undecided, but the suggestions made to ministers may suggest otherwise. What did the briefings say?

The NHSE culture leads to suppression of debate; it leads to cover-ups (uncovered); it leads to greater patient harm, with complicit staff hoping the patient harm won’t be discovered until their successors are in post. Institutional loyalty is to a fiction of Service, rather than to honesty about it. The culture refuses to learn unless made to.

Similarly, contempt of democracy and Parliament is not unusual in tech companies, but after Palantir’s involvement in the NHS, Palantir culture is spreading inside the Department of Health in England (DH/E) – public relations, not reliable statistics.

If you want to see what’s going to happen next, reading the Health Bill is not going to tell you very much – the Bill gives the Secretary of State a lot of power to do whatever they want, but there are no written proposals, no detailed speeches, no discussion of what that’ll be. It is Wes Streeting’s Health Bill, now in the hands of Andy Burnham’s government (which is a definite improvement).

The new Health Secretary, Yvette Cooper, has been around long enough to realise that reducing spending on a major NHS supplier, which is willing to hold cancer patients hostage and whose PR agency also represents the Opposition, is going to be a tricky needle to thread. Government has pathways forward, if there is a political choice to explore them.

Under the previous political leadership, only the most optimistic lines got briefed out by DH/E, on their own timescales, with the best possible framing.

“NHS App AI” “to help avoid the 8am rush” is the headline – unless the AI thinks you didn’t need an appointment,  in which case you’ll go towards the back of the queue, but maybe still ahead of people who didn’t use the App. (We’ll write on the App soon.) The thinking of DH/E staff is that pesky general practice will go the same way as your local bank branch. When NHSE says “neighbourhood health centre”, what they mean is “neighbourhood” like that served by your ‘nearest’ large post office, jobcentre, or bank.

“GPs have too much space” is the DH/E framing. Post-merger DH/E expecting well over half of GP surgeries to close in 2027/28 is the same story, with the same outcome. The ICB will cite the App as accounting for the majority of appointments and simply not give the GPs the budget that pays their rent. When other decision makers propose closing the last bank branch, the last pub, or the last post office in a village (or town), MPs write strongly worded letters in the face of public campaigns. Because NHSE won’t be around by then, NHSE’s planning assumes that MPs will be ignored, an assumption proven true in business, but in public service?

The NHS AI Platform, on which DH/E will run the AIs over the Single Patient Record, is the Palantir AI Platform with a new name. The Platform will be processing all your health notes, all your diagnoses, all your prescriptions. You will have to write your (mental) health needs down in a text box that the AI will analyse and the SPR will store, and an AI will compare every future time you ask for an appointment. The algorithmic transparency report will be ‘interesting’ – and show all the flaws that were simply never considered.

What was Wes’s choice will become Burnham’s burden.

Andy’s government has choices that new ministerial briefings might have omitted.

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